Cytological spectrum of granulomatous mastitis: diagnostic and treatment challenges

Background: Granulomatous mastitis (GM) is an inflammatory disease of the breast which clinico- radiologically mimics both inflammatory and malignant lesions. This leads to diagnostic dilemmas and delay in treatment. The aim of the present study was to review the cases diagnosed as granulomatous mastitis on Fine Needle Aspiration Cytology (FNAC) with an objective to co-relate their clinico-radiological findings, histology review where available and follow up treatment received to establish etiology and study the treatment outcome.Methods: Cytologically diagnosed cases of granulomatous mastitis were retrieved and reviewed from August 2015 - July 2017 records. Clinico-radiological co-relation, histology review where available and follow up treatment records were sought for.Results: Around 31.7% (530/1670) cases were reported as malignant, 60.3% (1009/1670) as benign proliferative and 7.9% (131/1670) as inflammatory lesions by breast FNA. 3.1% (51/1670) cases were reported as GM of all breast FNAC and 38% (51/131) of all inflammatory lesions. Follow up was available for 47 cases. Of which 26 (55.3%) cases were diagnosed as Tubercular Granulomatous mastitis (TGM) and 21(44.7%) were idiopathic granulomatous mastitis (IGM).Conclusions: Countries where tuberculosis is endemic, high degree of clinical suspicion and detailed work-up to rule out TGM is essential for all cases of granulomatous mastitis. Authors recommend a multidisciplinary workup with microbiological culture and molecular based tests on FNA material. This retrospective study illustrates that the cause of GM needs to be determined accurately for timely treatment, to avoid unnecessary delays and treatment dilemma in these patients

Diagnostic utility of cytospin, cell block and immunocytochemistry in pleural effusion cytology

Background: With the introduction of cytospin, the sensitivity of diagnosing malignancies has increased mainly due to the increase in cellular yield. Cell block also gives the advantage of ancillary testing and allows for retrospective studies. Immunocytochemical markers are used to differentiate and subtype various malignancies in body effusions.Aim of the study was to compare the morphological features of both technique and to assess the diagnostic utility of cell block methods in the cytodiagnosis of pleural effusions.Methods: This was a Prospective observational comparative study of two cytopreparatory techniques. All samples were examined and processed by cytospin and cell block techniques. Continuous data were expressed as Mean±SD (standard deviation) while categorical data were expressed in number, percentage and compared by chi-square (χ2) test.Results: The final diagnosis of both cytospin (147 cases) and cell block (150 cases) techniques was divided into four broad categories: Inadequate, Benign, Suspicious and Malignant. The significant diagnostic cytospin (AUC=0.857, p<0.001) in discriminating positive and negative malignant cases with 75.00% sensitivity (95% CI=53.3-90.2) and 100.00% specificity (95% CI=86.7-100.0) and with 100.0% positive predictive value and 81.2% negative predictive value. In contrast, cell block also showed significant diagnostic but with higher accuracy (AUC=1.000, p<0.001) and sensitivity 100.00% (95% CI=86.7-100.0) and specificity 100.00% (95% CI=86.7-100.0) and 100.0% positive predictive value and 100.0% negative predictive value than cytospin technique.Conclusions: Cell block as a technique should be used in routine practice as it not only increases the diagnostic yield but ancillary test can also be done

Isolated thoracic intramedullary epidermoid cyst - a rare entity

Intramedullary epidermoid cysts of the spinal cord are rare tumours, especially those not associated with spinal dysraphism. Around 60 cases have been reported in the literature. Of these, only 10 cases have had magnetic resonance imaging (MRI) studies. Here, we report a case of isolated intramedullary epidermoid tumour at D2-D3 level. The etiology, pathology, clinical features, MRI characteristics and surgical treatment of such rare intramedullary tumours are discussed

Drought and salinity stresses induced physio-biochemical changes in sugarcane: an overview of tolerance mechanism and mitigating approaches

Sugarcane productivity is being hampered globally under changing environmental scenarios like drought and salinity. The highly complex nature of the plant responses against these stresses is determined by a variety of factors such as genotype, developmental phase of the plant, progression rate and stress, intensity, and duration. These factors influence plant responses and can determine whether mitigation approaches associated with acclimation are implemented. In this review, we attempt to summarize the effects of drought and salinity on sugarcane growth, specifically on the plant’s responses at various levels, viz., physiological, biochemical, and metabolic responses, to these stresses. Furthermore, mitigation strategies for dealing with these stresses have been discussed. Despite sugarcane’s complex genomes, conventional breeding approaches can be utilized in conjunction with molecular breeding and omics technologies to develop drought- and salinity-tolerant cultivars. The significant role of plant growth-promoting bacteria in sustaining sugarcane productivity under drought and salinity cannot be overlooked

Clinico-Pathological Evaluation of Palpable Breast Lump: Hospital Based Prospective Study

Introduction: Breast lump remains a common complaint of females attending a surgical outpatient department. Different types of lesions ranging from inflammation to carcinoma can be presented as a breast lump. A definitive diagnosis of breast lump must be made by histopathological examination. In case of breast cancer, an early and accurate diagnosis can save the patient from metastases and may thus reduce mortality and morbidity. Aim &amp; Objective: The objective of the present study is to evaluate the clinical profile of patients who has palpable breast lumps and a wide range of breast diseases in palpable breast lumps. Histopathology was performed on these breast lumps. In addition to histopathology, clinico - pathological correlation was also done. Material and Methods: A prospective observational study was conducted for one year in the Department of Pathology, Vivekananda Polyclinic &amp; Institute of Medical Sciences (VPIMS), Lucknow. All patients with discrete breast lumps have undergone a triple assessment to make an early diagnosis. Surgical resection specimen includes lumpectomy and mastectomy. They were received, processed, reported and recorded in the Pathology laboratory and the data was collected and analysed. Result: All the cases had a unilateral side of the breast lump and most of the cases had a breast lump on the right side. The majority had lesion size between 2-5 cm, firm consistency, single lump/mass, spread in the outer quadrant. The clinical diagnosis was benign in 19 cases (45.2%) and malignant/suspected of malignancy in 23 cases (54.8%). The histopathological diagnosis was benign in 14 cases (33.3%), borderline in 2 cases (4.8%) and malignant in 26 cases (61.9%). Fibroadenoma was the most common benign tumour and invasive ductal carcinoma was the most common malignant tumour. Conclusion: The final histopathological examination confirmed that the few cases of clinically suspected benign breast lumps were actually borderline and malignant breast lumps. These cases confirm that the histopathological examination of a breast lump is the gold standard to establish a correct diagnosis

Metastasis of Maxillary Sinus Adenoid Cystic Carcinoma to the Humerus Bone—A Rare Case Report

Adenoid cystic carcinoma accounts for 10 to 12% of all salivary gland malignant neoplasms with an estimated incidence of 3 to 4.5 cases per million per year. Perineural spread and multiple local recurrences are its defining features, although the liver and lung are the most frequent sites for distant metastases. It is extremely uncommon for adenoid cystic carcinoma of the maxillary sinus to spread to distant bones. Few cases of adenoid cystic carcinoma with distant bone metastasis have been reported. Here, we report a known case of the adenoid cystic carcinoma of the maxillary sinus in a 40-year-old male, with isolated metastasis to the left humerus bone presenting 4 years later to the excision of the primary lesion. The fine-needle aspiration cytology, trucut biopsy, and immunocytochemistry of the left humerus osteoexpansile lesion confirmed the diagnosis of metastatic adenoid cystic carcinoma. This rare case report re-emphasizes the distant metastatic potential of adenoid cystic carcinoma

Liquid-based cytology versus conventional cytology in fine-needle aspirates of salivary gland neoplasms

Background: Liquid-based cytology (LBC) is a method of retrieving and processing of cytological material for the assessment of both gynecological and nongynecological cases introduced in 1996. Mostly conventional smears (CS) are prepared in Indian scenario; however, due to increasing popularity of LBC in nongynecology specimens, LBC is also used in few centers for diagnosing salivary gland neoplasm. Aim: The aim of this study is to compare CS and LBC in fine-needle aspiration cytology (FNAC) of the salivary gland neoplasms in terms of cytomorphological details, adequacy, ease of interpretation, pitfalls, and diagnostic efficiency. Materials and Methods: We conducted a prospective, observational, comparative study which included 64 salivary gland neoplasms. Both CS and LBC (SurePath) were prepared as per standard protocols and examined. Results and Conclusion: In our study, specificity and positive predictive value of both the techniques (conventional and LBC) were found to be 100%. Sensitivity of both the techniques was found to be similar (66.7%). Negative predictive value and diagnostic accuracy of conventional technique were found to be almost similar to that of LBC technique (97.6% vs. 97.2% and 97.7% vs. 97.4%). In terms of adequacy and cellularity, CSs were better than LBC. Ease of interpretation was better with CSs due to abundant chondromyxoid stroma, an important clue in the diagnosis of pleomorphic adenoma. Nuclear details and background were better in LBC as compared to CS. Hence, we conclude that in salivary gland FNAC, both CS and LBC have similar diagnostic efficiency. however, interpretation of conventional smears is easier than Liquid Based Cytology especially in cases of pleomorphic adenoma. However, some advantages of LBC in respect to conventional cytology, with better-preserved morphology obtained from LBC becomes furthermore obligatory

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VHL protein expression in renal cell carcinoma

Introduction: Various studies have been performed to detect VHL gene mutation in renal cell carcinoma (RCCs) but there is paucity of literature analyzing VHL expression at the protein level. Present study was carried out to analyze VHL protein (pVHL) expression in the tissue of RCCs and its correlation with tumor grade &amp; stage. Material and methods: Immunohistochemical detection of pVHL was done by using a mouse monoclonal antibody raised against amino acids 54-213 of VHL of human. Statistical analysis was done by using chi-square test and Kruskall Wallis H Test. Results: 32 patients of renal cell carcinoma were included in the study. pVHL expression was positive in 84.40% cases . Among all pVHL positive cases, combined cytoplasmic and nuclear expression of pVHL was most common (59.0%). Exclusive nuclear expression alone was rare and was noted in only one case. Chromophobe RCC (1 case) was negative for p VHL. Exclusive cytoplasmic pVHL expression was more frequently noticed in low grade tumors. Conclusion: VHL protein expression and its cytoplasmic and nuclear distribution is of potential relevance for the diagnosis and biological behavior of RCCs. Combined nuclear and cytoplasmic expression of VHL protein is more frequently seen in low grade and early stage of renal cell carcinomas